Sport and ageing: a systematic review of the determinants and trends of participation in sport for older adults

Mental Well-Being or Ill-Being through Coaching in Adult Grassroots Sport: A Systematic Mapping Review

There is convincing evidence on the effects of sport and exercise on mental health and well-being. Less evidence is provided about how to achieve these benefits in the context of grassroots sport coaching. We systematically reviewed the scientific literature of three databases to narratively synthesize the current knowledge about which coaching-related factors influence well-being or ill-being, and how to promote mental health in adult athletes through sport coaches. The review includes 52 studies with different methodological and theoretical approaches and mental health outcomes. The wide range of themes were mapped and synthesized within two clusters, i.e., coaching behavior, antecedents, and context; and coach–athlete relationship and social support. The results highlight the importance of the promotion of empowering environments, autonomy-supportive coaching behavior, and coach–athlete relationship quality that relate to the satisfaction of basic psychological needs. The review also calls for a critical perspective, in the sense that the coaching context and working environment may not be empowering and supportive to the well-being of coaches and consequently to the athletes, and that coaches who want to provide autonomy-supportive environments may face various obstacles. Finally, the review synthesizes recommendations for the training of coaches, as one piece of a holistic mental health promotion.

Utilizing Developmentally Essential Secreted Peptides Such as Thymosin Beta-4 to Remind the Adult Organs of Their Embryonic State-New Directions in Anti-Aging Regenerative Therapies

Our dream of defeating the processes of aging has occupied the curious and has challenged scientists globally for hundreds of years. The history is long, and sadly, the solution is still elusive. Our endeavors to reverse the magnitude of damaging cellular and molecular alterations resulted in only a few, yet significant advancements. Furthermore, as our lifespan increases, physicians are facing more mind-bending questions in their routine practice than ever before. Although the ultimate goal is to successfully treat the body as a whole, steps towards regenerating individual organs are even considered significant. As our initial approach to enhance the endogenous restorative capacity by delivering exogenous progenitor cells appears limited, we propose, utilizing small molecules critical during embryonic development may prove to be a powerful tool to increase regeneration and to reverse the processes associated with aging. In this review, we introduce Thymosin beta-4, a 43aa secreted peptide fulfilling our hopes and capable of numerous regenerative achievements via systemic administration in the heart. Observing the broad capacity of this small, secreted peptide, we believe it is not the only molecule which nature conceals to our benefit. Hence, the discovery and postnatal administration of developmentally relevant agents along with other approaches may result in reversing the aging process.

Goal Orientation and Physical Activity: Psychometric Properties of the Polish Version of the Goal Orientation in Exercise Measure (GOEM)

Motivational factors are among the most important determinants of undertaking and participating in physical activity. An adequate measurement of motivation and the assessment of its initial characteristics form the basis for possible further practical interventions of a compensatory or promotional nature. Considering the above, the main aim of this study was to assess the psychometric properties of the Polish version of the Goal Orientation in Exercise Measure (GOEM), and to determine the association between the task and the ego orientations and selected components of physical activity, i.e., frequency of undertaking, declared time per session and time spent on physical activity. In addition to the typical indices of psychometric assessment, an analysis of the reliability of test items by applying the item response theory (IRT) model was also presented. The study included 318 individuals (173 females, 145 males), aged 21 years on average, undertaking recreational physical activity. The GOEM scale by Petherick and Markland (2008) was used. The model of the Polish version of the GOEM scale fitted the empirical data well (CFI = 0.955). Satisfactory reliability indices were also obtained (task subscale: alpha = 0.83, omega = 0.83; ego subscale: alpha = 0.86, omega = 0.86). Reliability, as assessed by the test-retest method, was ICC = 0.80 for the task subscale and ICC = 0.87 for the ego subscale. The IRT analysis showed that the ego subscale was more precise in the middle level of the trait, while the task subscale provided more information in the low and middle level of the trait and relatively little information in the high level of the trait. The positive associations of the task subscale with the frequency of physical activity and the time spent in a single exercise session were also noted.

Size matters: locality of residence and media use in later life

Various factors determine the use of media in later life. Nevertheless, spatial inequalities among older media users have been accorded little attention in academic research. This study aimed to explore differences in variety (number) and intensity (duration) of both traditional and new media use among older adults residing in various types of localities. Data were obtained from the second wave of the ACT (Ageing + Communication + Technology) cross-national survey, comprising 7,927 internet users aged 60 and over from seven countries. The statistical analyses used in the study were chi-square and analysis of variance tests, and linear regression as a multivariate technique. The results indicated that spatial differences concern variety of media use to a greater extent than its intensity, especially with regard to use of traditional media via new devices. Overall, residents of large cities exhibited greater variety and intensity of media use than did their counterparts from smaller localities, especially rural ones. These findings supported the social stratification hypothesis – according to which individuals from more-privileged social backgrounds have better media literacy, use media to a greater extent and benefit from its use more than people from disadvantaged groups. The findings should be considered by practitioners and policy makers.

Healthy Lifestyle Recommendations: Do the Beneficial Effects Originate from NAD+ Amount at the Cellular Level?

In this review, we describe the role of oxidized forms of nicotinamide adenine dinucleotide (NAD⁺) as a molecule central to health benefits as the result from observing selected healthy lifestyle recommendations. Namely, NAD⁺ level can be regulated by lifestyle and nutrition approaches such as fasting, caloric restriction, sports activity, low glucose availability, and heat shocks. NAD⁺ is reduced with age at a cellular, tissue, and organismal level due to inflammation, defect in NAMPT-mediated NAD⁺ biosynthesis, and the PARP-mediated NAD⁺ depletion. This leads to a decrease in cellular energy production and DNA repair and modifies genomic signalling leading to an increased incidence of chronic diseases and ageing. By implementing healthy lifestyle approaches, endogenous intracellular NAD⁺ levels can be increased, which explains the molecular mechanisms underlying health benefits at the organismal level. Namely, adherence to here presented healthy lifestyle approaches is correlated with an extended life expectancy free of major chronic diseases.

Experiences and Strategies Influencing Older Adults to Continue Playing Walking Football

Adults aged 55+ years are most likely to be inactive, despite research suggesting that older adults experience multiple benefits when participating in physical activity and sport. Limited research focuses on long-term continuation of sport participation in this population, especially in "adapted sports" like walking football. This study explored the experiences of walking football maintenance in 55- to 75-year-old players. Semistructured interviews were conducted, with 17 older adults maintaining walking football play over 6 months. The inductive analysis revealed five higher-order themes representing maintenance influences and two higher-order themes relating to maintenance mechanisms (i.e., the conscious process by which players maintain). Influences when maintaining walking football included individual- and culture-level influences (e.g., perceived benefits of maintenance and ability acceptance). Maintenance mechanisms included cognitions and behaviors (e.g., scheduling sessions and redefining physical activity expectations). Findings highlight novel implications for policy and practice, which are important to consider when delivering walking football to older adults.

Reasons why older adults play sport: A systematic review

BACKGROUND

Despite the known contribution of sport to health and well-being, sport participation declines in older age. However, for some people, sport continues to play an important role in older age and may contribute to improved health and well-being in older years. Although the health-related benefits of participating in sport are commonly reported, the reasons why some older adults continue to play sport are not well understood. This systematic review aimed to (1) identify studies from the literature that evaluated the reasons why older adults (aged 55 years and older) participate in sport and (2) synthesize and discuss the reasons for their participation reported in the literature.

METHODS

Searches of the electronic databases Embase, Medline, PsycInfo, PubMed, and SPORTDiscus were performed. Studies were included that evaluated reasons for sport participation in adults aged 55 years and older because this is the age at which sport participation has been reported to begin declining. The studies included in this review used qualitative, quantitative, or mixed methods designs, were peer reviewed, and were published in the English language before the search date (20 January 2019).

RESULTS

A total of 1732 studies were identified. After exclusions, 30 studies were included in the review (16 qualitative, 10 quantitative, and 4 mixed methods). The review presents several features and findings from the studies, including a description and systematization of the reasons for participating in sport and the main reasons that participants gave for participating in sport (maintaining health, feeling and being part of a community, and taking advantage of opportunities to develop relationships). Other reasons included competing and attaining a feeling of achievement, taking advantage of opportunities for travel, and being part of a team. Sport was identified as contributing to the overall experience of successful ageing. There were few comparative differences for participating in sport, and there were only small differences between genders for the reasons given for participation. Generally, the quality of the studies was good; however, mixed methods studies lacked appropriate data analysis procedures.

CONCLUSION

Older adults play sport for a range of health-related and social reasons that can contribute to the experience of successful ageing. Strategies to increase sport participation by older adults should focus on promoting these aspects.

Changes in alcohol consumption, body weight and physical activity among breast cancer survivors and population-based unaffected women in a prospective study

BACKGROUND

It is unclear whether a breast cancer diagnosis affects health behaviour changes that occur with ageing. We aimed to compare long-term changes of alcohol consumption, body weight, and physical activity in women with breast cancer and in age-matched unaffected women.

METHODS

We used data from 1,925 women with breast cancer and 3,473 unaffected women aged 50-74 years enrolled in the population-based case-control study MARIE (Mamma Carcinoma Risk Factor Investigation) in 2002-2005, who also completed the follow-up in 2014-2016. Multinomial logistic regression was applied to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for the associations between breast cancer status and categories of change in alcohol consumption, weight and physical activity.

RESULTS

After 11.6 years of follow-up, breast cancer survivors had significantly lower odds than unaffected women of increasing alcohol consumption from ≤10 to >10 g/day (adjusted OR 0.48, 95 % CI 0.35-0.65), but were more likely to experience a major weight change of ≥10 % compared to having stable weight (±<5 %) (OR for increase and decrease 1.32, 95 % CI 1.03-1.70 and 1.36, 95 % CI 1.05-1.77, resp.) and to decrease transport physical activity to below 2.5 h/week compared to maintaining the activity level (OR 1.61, 95 % CI 1.26-2.04). No significant group difference was found for changes in recreational physical activity.

CONCLUSION

Our data indicate that some long-term health behaviour changes can be attributed to a breast cancer diagnosis rather than ageing, suggesting that long-term medical care of breast cancer survivors could pay greater attention to weight control and sufficient physical activity.

From the Roman Empire to the New Millennium. Data access and sharing from healthy ageing cohorts

Cohort studies are the best way to analyze the incidence and natural history of a disorder, permitting to assess associations between multiple exposures and multiple outcomes. A well-designed cohort may be particularly relevant regarding the study of the ageing processes of adult populations, allowing the study of processes and dynamics of the individual life course and the study of the effects of earlier exposures and characteristics on later outcomes. Moreover, cohort studies seem the best instrument to analyze the factors favoring active and healthy ageing, and to increase knowledge about the most appropriate interventions to enhance older population’s wellness. Nonetheless, the number of cohorts on ageing is limited, because they are very expensive to develop, establish, and maintain, requiring long-term investment to be efficiently performed to obtain all the data needed to address the longitudinal research questions. Open data and data sharing should be encouraged to ensure verifiable, reproducible and transparent results, and to allow the generation of new knowledge in the context of earlier discoveries. Making cohort studies “open” can foster the efforts of the scientific community committed in the study of ageing and give a real contribution to the well-being of the ageing population.

KEY-MESSAGE:•

Cohort studies are the best way to analyze the incidence and natural history of a disorder, the factors favoring active and healthy ageing, and to increase knowledge about the most appropriate interventions to enhance older population’s wellness.

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Making cohort studies “open” can foster the efforts of the scientific community committed in the study of ageing and give a real contribution to the well-being of the ageing population.

Participation in sports/recreational activities and incidence of hypertension, diabetes, and obesity in adults

Evidence of prospective associations between participation in sports and recreational activities (SRAs) and health outcomes at the population level is scarce. We investigated the associations between participation in SRAs and 6-year incidence of hypertension, diabetes, and obesity in a cohort of mid-age Australian adults. We analyzed data from the HABITAT study (n = 8784), a cohort of adults aged 40+ years living in Brisbane, Australia. Mail surveys in 2007, 2009, 2011, and 2013 were used to collect data on participation in 11 SRAs in the past 12 months, as well as self-reported hypertension, diabetes, height, and weight. Obesity was defined as BMI ≥ 30.0 kg/m² . Logistic generalized estimating equation models with a 2-year lag were used. Participation in SRAs in 2007, 2009, and 2011 was matched with outcomes measured in 2009, 2011, and 2013. From 2007 to 2013, the cumulative incidence of hypertension, diabetes, and obesity was 14.9%, 3.2%, and 11%, respectively. Running, tennis, team sports, exercise classes, and resistance training were associated with reduced odds of hypertension. Running, cycling, resistance training, and yoga/tai chi were associated with reduced odds of diabetes. Cycling, tennis, home-based exercises, resistance training, and yoga/tai chi were associated with lower odds of obesity. Participation in SRAs was associated with lower incidence of hypertension, diabetes, and obesity in mid-age adults over six years. These findings support current efforts to promote wider and continuing participation in SRAs at this life stage.

Perception of aging in the relation between sport activity and self-rated health in middle and older age - A longitudinal analysis

Background

This study aims to generate more comprehensive knowledge regarding underlying mechanisms of health production in middle and older age by focusing on perception of aging in the relation between sport activity and self-rated health. More differentiated information can be generated by using more age-specific data and applying advanced empirical methods.

Methods

Panel data from the German Ageing Survey (DEAS) (n = 1027) is used, whereby individuals are included, that participated at least in two waves. First, a blockwise fixed effects logistic regression model is carried out, which allows to investigate mediation as well as moderation effects and controls for time invariant unobserved heterogeneity. Additionally, two recursive bivariate probit models are conducted to identify further indirect pathways.

Findings

A mediating and moderating effect of perception of aging regarding self-rated health is found in the fixed effects model. Indirect pathways of perception of aging and retirement over sport activity (mediator) are confirmed in the recursive bivariate probit models.

Conclusion

The results highlight the complexity of the underlying mechanisms as well as the importance of individual and needs-based designed health promotion. Here, public health policy should not solely focus on sport activity, rather it should include target group specific strategies to shape individual perceptions of aging towards a more positive view on aging, while considering the heterogeneity of middle and older age groups.

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Sport activity and health-specific perception of aging are positively associated with self-rated health.

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A mediating and moderating effect of perception of aging on sport activity regarding self-rated health is found.

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Indirect pathways of perception of aging and retirement over sport activity are confirmed.

Experiences Influencing Walking Football Initiation in 55- to 75-Year-Old Adults: A Qualitative Study

Adults aged 55 and older are least likely to play sport. Despite research suggesting this population experiences physical and psychological benefits when doing so, limited research focuses on older adult sport initiation, especially in "adapted sports" such as walking football. The aim of this study was to explore initiation experiences of walking football players between 55 and 75 years old. Semistructured interviews took place with 17 older adults playing walking football for 6 months minimum (Mage = 64). Inductive analysis revealed six higher order themes representing preinitiation influences. Eight further higher order themes were found, relating to positive and negative experiences during initiation. Fundamental influences preinitiation included previous sporting experiences and values and perceptions. Emergent positive experiences during initiation included mental development and social connections. Findings highlight important individual and social influences when initiating walking football, which should be considered when encouraging 55- to 75-year-old adults to play adapted sport. Policy and practice recommendations are discussed.

Requirements for (web-based) physical activity interventions targeting adults above the age of 65 years - qualitative results regarding acceptance and needs of participants and non-participants

Background

It remains unclear how physical activity (PA) interventions need to be designed to reach older adults and to be widely accepted in this target group. The aim of this study was to assess the acceptance of a web-based PA program, including individual intervention components as well as relevant contextual factors, and to specify requirements for future interventions.

Methods

Two hundred sixty-six participants of a PA intervention completed a questionnaire covering individual program components (content, structure, and context). Further, 25 episodic guided interviews focusing on reasons for (non-) participation were conducted with 8 participants and 17 non-participants. Following qualitative content analysis, different requirements were identified and organized based on the social-ecological model, resulting in a profile of requirements.

Results

Based on the participants’ and non-participants’ statements, six different levels of requirements affecting acceptance of and successful participation in a web-based PA intervention were identified. The individual fit was influenced by an interaction of different factors at the intrapersonal, sociocultural, content, spatial, digital and organizational levels. Several age- and gender-specific requirements were noted in the interviewed older adults. Men and women, as well as younger (< 70 years) and older (≥70 years) adults differed in terms of perceived enjoyment and benefits of socializing while exercising together, the time expenditure perceived to be acceptable, previous digital skills, as well as in perceptions that ambience and accessibility of exercise facilities in the neighborhood were important.

Conclusions

To motivate older adults to engage in PA and address different needs in terms of life circumstances and quality of life as well as differences in technical affinity, different requirement profiles should be included in the process of intervention development and implementation. Participatory development loops and modular offer formats are recommended for this.

Sport as a Leisure Occupation in Occupational Therapy Literature: A Scoping Review

IMPORTANCE

The focus of occupational therapy is often on personal care, life skills, and daily living. Sport, as a type of leisure activity, can also provide benefits to health and well-being. Occupational therapy practitioners should therefore promote the role of sport in the lives of clients.

OBJECTIVE

To investigate the extent, range, and nature of peer-reviewed occupational therapy literature investigating sport as a leisure occupation.

DATA SOURCES

The following databases were searched: Embase, MEDLINE, OTseeker, PsycINFO, PubMed, and SPORTDiscus.

STUDY SELECTION AND DATA COLLECTION

We identified published studies investigating competitive sport in occupational therapy research or practice. Included studies investigated adult participants (age ≥18 yr) participating in sport, had a clear occupational therapy input, and were written in the English language.

FINDINGS

Six studies met the inclusion criteria. Only 2 of the 6 studies identified through the search strategy were conducted after 2004, diagnosis and outcome measures varied widely, and sport as a leisure occupation was found to have positive individual outcomes.

CONCLUSIONS AND RELEVANCE

Opportunities exist to investigate sport as a leisure occupation and its involvement in occupational therapy practice. Future research may contribute to positive outcomes and experiences for clients who receive occupational therapy.

WHAT THIS ARTICLE ADDS

This scoping review describes literature about sport as an occupation and highlights the opportunities for practitioners and researchers to incorporate sport as a leisure occupation.

"You Can Sit in the Middle or Be One of the Outliers": Older Male Athletes and the Complexities of Social Comparison

Sporting events for older adults are proliferating in both popularity and participation numbers, mirroring the growth that is occurring globally with an aging population. Preliminary evidence indicates that older athletes have a tendency to compare themselves (in terms of their performance, participation, and aging) to inactive older adults deemed “worse-off.” Our aim was to examine the stories and experiences of older, male Masters athletes, not only in terms of their own lives and in relation to others but also in the broader context of current (neoliberal) policies that promote sport across the lifespan. We use social comparison theory to interpret our findings and highlight the strengths and limitations of social comparison as a psychological strategy. For this study, 17 male competitive athletes (age range from 70 to 90 years) who participated in either the 2013 or 2017 World Masters Games were interviewed as part of a larger project on the meaning of sport in their lives. Seven different sports were represented, and participants hailed from multiple countries. Within the interpretive paradigm, we used qualitative methods to interview each participant, analyze individual transcripts, and develop common themes across the data set to address the aforementioned aims. Our two major themes were, Sport as social comparison:“It’s the competitive nature” and Downward comparisons. A number of participants commented on the nature of sport, and competitive sport in particular, as being important to their motivation to train and prepare. Within the theme of Downward comparisons, we established two categories: Resisting loss and Assigning blame. While downward comparisons were used by our participants to separate themselves from other seniors of the same age, thereby bolstering their sense of self, participants also tied those comparisons to neoliberal notions of individual and moral responsibility for health. Participants believed that compromised health was due to individual negligence and bad decisions, with little reference to uncontrollable factors, such as non-modifiable risk factors for disease, disability, and/or socioeconomic status, which could be affecting people’s lives or decisions. Ultimately, our findings show that the useful psychological strategy of social comparison for maintaining a positive sense of self and performance may also have some negative individual and societal consequences.

The role of individual resources, health behaviour and age perception as determinants of sports participation in older age

Sports participation contributes to maintaining health and wellbeing in old age, hence a deeper understanding of its various determinants is necessary. Previous research has primarily focused on either the effects of individual resources or age-specific attitudes to sports participation. However, a deeper understanding of the inter-relationships between these variables is required to develop effective policies to promote sports participation in ageing societies. To address the hypothesised inter-relationships, we consider both individual resources as well as age-specific attitudes and behaviours in order to integrate them simultaneously in our analysis. Furthermore, the analysis will be differentiated according to the three social status groups. The sample contains 1,560 retired persons, aged 65 years and older, based on the fifth wave (2014) of the German Ageing Survey. Multiple Poisson regression models were estimated to test our hypotheses. After adjusting for demographic variables, greater individual resources are associated with more regular sports participation. The findings also reveal that positive age perception and healthy behaviours are related to sports participation. Slight mediation effects between the different variables can be observed. Furthermore, the effect structures vary across different social status groups. The findings show that both individual resources and age-specific behaviours and attitudes are independent determinants of sports participation in older age. Our results confirm slight inter-relationships between socio-economic resources and age-specific attitudes.

Short-Term and Medium-Term Impact of Retirement on Sport Activity, Self-Reported Health, and Social Activity of Women and Men in Poland

Background. The aim of this study was to assess how retirement affects the short-term (up to 2 years after retirement) and medium-term (2-4 years) sport/exercise activity (S/EA) of Poles. To gain a broader context for interpretation, the effect of retirement on self-rated health status, attitudes, social activity, and sexual life was analysed. Methods. A quasiexperiment utilizing data from the longitudinal study Social Diagnosis and radius-matching method was conducted. Retiring men and women were matched with similar, nonretiring ones to make comparisons of differences in S/EA and other outcomes interpretable in terms of causality. Results. Retirement does not have a significant effect in the short term on S/EA of men (p=.440) and women (p=.340). The satisfaction of men with their health status in this period was improved (p=.007), although they more often declared health problems that impaired their everyday functioning (p=.045). Women rarely reported serious health problems (p=.024). In the medium perspective, retirement had the effect on reducing S/EA in men (p=.012) and various dimensions of their social life. Although men tend to worry more often about their health (p<0.001), they are less likely to suffer from problems with moving (p=.001) and fatigue (p=.013). Despite the fact that women are more often satisfied with their health (p=.027), they also more often complain about heart or chest pain (p=.010), body pain (p=.009), and fatigue (p=.007). Conclusion. It is necessary to prepare employees for retirement much earlier than in the preretirement age. In addition to raising awareness of the effect of S/EA functions, it is necessary to monitor the physical activity of employees and to use appropriate programmes for (1) maintaining motivation among employees who are physically active before they retire and (2) raising awareness and encouraging physical activity in employees who are physically passive.

Health-Related Lifestyle Behavior and Religiosity among First-Generation Immigrants of Polish Origin in Germany

Background: Health-related lifestyle behaviors such as smoking, alcohol consumption, physical inactivity and obesity are major cardiovascular risk factors. Previous studies have mostly demonstrated a favorable association between religiosity and these cardiovascular risk factors; however, no studies have investigated this relationship in Polish immigrants. The aim of this cross-sectional study was to examine the association between health-related lifestyle behaviors and religiosity in Polish immigrants in Germany. Methods: The smoking patterns, frequency of alcohol consumption, physical activity, and presence of overweight/obesity were assessed in 257 first-generation immigrants of Polish origin living in Germany. Religiosity was measured with the Centrality of Religiosity Scale (CRS, Huber, 2003) consisting of 15 items that categorized the respondents into intrinsically, extrinsically, and not/marginally religious. Results: After adjusting for various sociodemographic, migration, and health-related characteristics, intrinsic religiosity was significantly associated with a lower risk of being a smoker (odds ratios (OR) = 0.34, confidence intervals (CI) = 0.15–0.76) and was also associated with a lower risk of alcohol consumption (OR = 0.33, CI = 0.15–0.71), but a higher risk of being overweight/obese (OR = 2.53, CI = 1.15–5.56) in comparison with extrinsic/marginal religiosity. No significant relationship was found between religiosity and physical activity. Conclusions: In Polish immigrants, intrinsic religiosity acts as a protective factor against some cardiovascular risk factors (smoking and alcohol consumption).

Sport for Adults Aged 50+ Years: Participation Benefits and Barriers

Despite the health benefits of sport, the proportion of people participating in sport decreases with age. This qualitative study explored the benefits and barriers regarding older adult community sport participation, from the perspective of national sporting organizations, in addition to older adult sport club and nonsport club members, across eight focus group interviews (n = 49). Seven benefits were discussed, primarily social and physical health and intergenerational opportunities. Ten barriers were also discussed, including physical health, time constraints, and lack of appropriate playing opportunities. Ensuring access to activities that can benefit social health is of great importance to older adults. As sport can provide participation opportunities across generations, it can be an ideal physical activity option for this age group. However, a major barrier is that sport policy often prioritizes the participation for younger age groups. Policymakers should include a focus on older adults, to derive social health benefits.